A MODIFIED THORACOTOMY FOR MINIMALLY INVASIVE CORONARY-ARTERY BYPASS-GRAFTING

The optimal technique of minimally invasive coronary artery revascular ization using the in situ internal thoracic artery (ITA), without extr acorporeal circulation, is yet to be defined. To obtain adequate expos ure for both ITA harvest and left anterior descending coronary artery anastomosis, an anterior chest wall defect is created which can be dif ficult to reconstruct. Based on the Vascular anatomy of the acromiotho racic axis and three described osteocutaneous composite tissue flaps, we present a novel dissection that not only improves exposure, but als o preserves chest wall integrity.